BACKGROUND Children hospitalized with COVID-19 are at risk for severe complications, yet comprehensive data remain limited. We evaluated intensive care unit (ICU) admission, mortality, hospital and ICU length of stay (LOS), 30-day readmission, and demographic and clinical predictors among hospitalized pediatric patients. METHODS We conducted a retrospective cohort study using the Vizient Clinical Database, including patients aged 0 to 21 years hospitalized with COVID-19 from March 2020 to December 2023. Multivariable models evaluated associations between outcomes and demographic characteristics, comorbidity systems, and in-hospital interventions. RESULTS Among 101 187 hospitalized children across 1028 US medical centers, 19.9% required ICU admission, 8.9% were readmitted within 30 days, and 1.0% died. This mortality rate reflects hospital-based deaths and does not represent population-level risk. The average LOS was 5.4 days. Older age was associated with higher mortality, readmission, and hospital LOS but shorter ICU LOS. Neurologic, cardiovascular, endocrine, immune, and hematologic comorbidity systems were consistently associated with adverse outcomes, whereas asthma, diabetes, and sickle cell disease were associated with shorter LOS and reduced mortality. In-hospital respiratory support, peripherally inserted central catheter line placement, and cardiopulmonary resuscitation strongly predicted poor outcomes. CONCLUSIONS This large multicenter cohort identifies key demographic and system-level comorbidity factors associated with adverse pediatric COVID-19 outcomes. Race and ethnicity were analyzed as social constructs to evaluate inequities rather than biological traits. Findings indicate that older adolescents and children with multisystem chronic conditions require enhanced monitoring, whereas several common conditions exhibit more favorable trajectories. Results support targeted inpatient management, surge planning, and refinement of pediatric COVID-19 care pathways.
Wilkins et al. (Sun,) studied this question.